Anor Cassandra J, O'Connor Sean, Saund Amardeep, Tang-Wai David F, Keren Ron, Tartaglia Maria Carmela
Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada.
Neurodegener Dis. 2017;17(4-5):127-134. doi: 10.1159/000455127. Epub 2017 Mar 1.
BACKGROUND/AIMS: Neuropsychiatric symptoms (NPS) are common in Alzheimer disease (AD) and vascular dementia (VaD), and are distressful to patients and caregivers. NPS are likely related to the underlying pathology. Previous studies suggest that frontal lobe lesions and vascular changes such as white matter hyperintensities (WMH) have a significant association with specific NPS. The current study aimed to compare NPS in patients with AD, VaD, and mixed AD/VaD, and to evaluate the differences in the prevalence of NPS in relation to frontal WMH volume.
In total, 180 patients with NPS and MRI data (92 probable AD, 51%; 34 probable VaD, 19%; and 54 probable mixed AD/VaD, 30%) were included in the study. Regression analyses were performed to determine the relationships between NPS prevalence and diagnosis, and between NPS and frontal WMH.
VaD patients had significantly more agitation (p < 0.05; 40 vs. 14%) and sleep disturbances (p < 0.05; 57 vs. 32%) than AD patients, and significantly more depression (p < 0.05; 48 vs. 20%) and aberrant motor behaviors (p < 0.05; 31 vs. 13%) than mixed AD/VaD patients. AD patients with delusions had significantly greater right frontal WMH volumes than those without (p < 0.05; delusions 1/0 = 314.8/112.6 mm3).
Differences in NPS prevalence are likely related to the underlying pathology and warrant further study as they have implications for treatment.
背景/目的：神经精神症状（NPS）在阿尔茨海默病（AD）和血管性痴呆（VaD）中很常见，给患者和照料者带来困扰。NPS可能与潜在病理状况相关。既往研究提示额叶病变和诸如白质高信号（WMH）等血管变化与特定NPS显著相关。本研究旨在比较AD、VaD及AD/VaD混合型患者的NPS，并评估与额叶WMH体积相关的NPS患病率差异。
本研究共纳入180例有NPS且有MRI数据的患者（92例可能为AD，占51%；34例可能为VaD，占19%；54例可能为AD/VaD混合型，占30%）。进行回归分析以确定NPS患病率与诊断之间以及NPS与额叶WMH之间的关系。
与AD患者相比，VaD患者有更多的激越（p<0.05；40%对14%）和睡眠障碍（p<0.05；57%对32%），与AD/VaD混合型患者相比，有更多的抑郁（p<0.05；48%对20%）和异常运动行为（p<0.05；31%对13%）。有妄想的AD患者右侧额叶WMH体积显著大于无妄想的患者（p<0.05；妄想1/0=314.8/112.6mm³）。
NPS患病率的差异可能与潜在病理状况相关，鉴于其对治疗有影响，值得进一步研究。
